Psychiatry & Internal Medicine – an inseparable link

Volume 6 Issue 12 December, 2016

Consultation Liaison Psychiatry Focus: Internal Medicine

Internal medicine and Psychiatry are sisters in the real sense. Patients having medical problems often have co-existing psychiatric disorders, appropriate diagnosis and management often improves patient outcomes. The origin of Psychiatry as a new specialty was based on the principle of inseparability of psychiatry from medicine. Johann Christian Reil, the German physician credited to be the creator of Psychiatry was of the opinion that Psychiatry was on the three main branches of medicine, others being medicine and surgery.

The interaction between mind and body is often the determinant of diseases and their response to treatment. Reil was very right in postulating that diseases cannot have sole chemical, mechanical or physical causes, often the three interact in causing and manifesting the disease.

We as physicians often encounter these mind-body interactions in our routine practice. For instance, many a times a patient having poorly controlled diabetes mellitus when evaluated for mental health is often diagnosed to be suffering from depression. Adequate management of depression usually culminates in better treatment compliance and adherence to diet and life style recommendations resulting in better glycemic control.

Another instance is that of ICU psychosis, patients who are severely ill often on ventilators and admitted in the ICU for a long time often land up into ICU psychosis. This further complicated the clinical picture and delays recovery. At times we physicians need help from psychiatrists in identifying and managing ICU psychosis which often results in reduction in time spent in the ICU and prompt and favorable treatment outcome.

We physicians often come across functional disorders of which there is no physical basis like Irritable bowel syndrome, low backache, chronic gastritis, chest pain and palpitations. Identification of the underlying psychiatric disorder like depression, anxiety, somatoform disorders helps in improving patient recovery. Abnormal illness behavior often needs help from a psychiatrist for appropriate management.

Appropriate psychiatric assessment often translated in huge monetary benefits in terms of avoiding unnecessary medical investigations, multiple medical visits and doctor shopping. The improvement in clinical outcome improves functionality hence improving quality of life.

The contribution of a psychiatrist is essential in delivery of medical care. As a sound body needs presence of a sound mind, psychiatrist helps in diagnosis and management of unsound mind which helps in improving the physical health of the patient.